Healthcare Provider Details

I. General information

NPI: 1811718893
Provider Name (Legal Business Name): BRENDA REYES BARRERAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 W DR MARTIN LUTHER KING JR BLVD STE 500
TAMPA FL
33607-6220
US

IV. Provider business mailing address

11509 COLONY HILL DR APT B
SEFFNER FL
33584-7362
US

V. Phone/Fax

Practice location:
  • Phone: 813-289-0760
  • Fax:
Mailing address:
  • Phone: 561-291-3149
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: